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Comparative analysis of perinatal health outcomes among refugee subgroups and economic immigrants in Canada
Marwa Ramadan1,2, Gabriel D Shapiro3, Seungmi Yang3
1Department of Sociology, McGill University, Montreal, Quebec, Canada.
Background:
Refugees often face increased risks of poor perinatal health outcomes compared to native-born individuals and non-refugee immigrants. However, limited research has explored how birth outcomes vary across refugee subgroups in Canada, especially compared to economic immigrants and among refugee groups themselves. This study aimed to (1) compare the risk of preterm birth (PTB), small-for-gestational-age (SGA), large-for-gestational-age (LGA), stillbirth, and infant mortality between refugee subgroups and economic immigrants, and (2) examine differences among Government-Assisted Refugees (GARs), Privately Sponsored Refugees (PSRs), and In-Canada Refugees (ICRs).
Methods:
This population-based study used data from the Migrant Maternal and Infant Morbidity and Mortality (MIMMM) dataset, including 706,620 singleton births from 2000 to 2017. Generalized estimating equation models calculated adjusted risk ratios (aRRs) for birth outcomes, accounting for maternal and immigration-related factors.
Results:
All refugee subgroups had higher PTB (6.26-6.41 per 100 births) and LGA rates (8.65-9.17 per 100 births) but lower SGA rates (9.53-10.40 per 100 births) compared to economic immigrants (PTB: 5.95, LGA: 7.36, SGA: 10.96). After adjustment, GARs maintained higher PTB risks, and all refugee subgroups had lower SGA and higher LGA risks than economic immigrants. Within refugee subgroups, ICRs had higher SGA risks (aRR = 1.09; 95% CI: 1.04-1.14) than GARs, and PSRs (aRR = 1.22; 95% CI: 1.04-1.44) and ICRs (aRR = 1.28; 95% CI: 1.07-1.52) had higher stillbirth risks than GARs.
Conclusion:
Refugee women in Canada have higher risks of PTB and LGA births compared to economic immigrants. ICRs had higher risks of SGA births and stillbirths than other refugee subgroups but lower risks of SGA and stillbirths compared to economic immigrants. These disparities are partly explained by maternal and immigration-related factors. Further research is needed to better understand these factors and inform policies aimed at reducing health disparities among immigrant populations in Canada.
